A Day in the Life of a Nephrology Nurse

In honor of Nephrology Nurses Week, we wanted to give readers a peak into the daily life of nephrology nurses. Of course, especially in nursing, days can be quite different depending on the patients you’re serving or what department you’re working in. For the following three nurses, though, they’ve presented a glimpse of a typical day in nephrology.

“The day in the life of a nephrology nurse can vary greatly! Nephrology nurses are more than just technical experts. There are many areas of knowledge that nephrology nurses provide to their patients other than just the technical aspects of dialysis care. Some of those may include the roles of caregiver, advocate, educator, facilitator, and mentor. Nephrology nurses may provide care in a hospital, a physician’s office, a dialysis unit, a nursing home, a prison, or a university. In fact, one of the best aspects of the specialty is the diversity of nephrology nursing roles and settings. Nephrology nurses can also help provide care to patients anywhere along the spectrum of renal disease. Chronic kidney disease (CKD) is listed in stages from 1 to 5, so nurses can work with patients anywhere on that continuum. Nephrology nurses’ responsibilities vary based on the setting. In an outpatient dialysis unit, the nurse is responsible for providing the dialysis therapy as ordered by the physician or nurse practitioner, as well as educating patients about their disease, their diet, their medications, and a host of other areas. If the patient chooses a home dialysis therapy, the nurse is responsible for teaching the patient and his or her family members how to perform that therapy in their home. In an inpatient hospital unit, the nurse is responsible for providing the acute care to help the patient recuperate sufficiently to be discharged home. A transplant coordinator is responsible for educating a patient about transplantation, coordinating a team to perform an evaluation to assess for suitability for transplant, and education and support after the transplant.”

“Hemodialysis nurses provide care to patients with chronic kidney disease requiring hemodialysis. Hemodialysis involves teamwork, in which nurses work with certified hemodialysis technicians in giving direct patient care and coordinate their care with the health care team (nephrologists, dietitian, social worker, etc.). Hemodialysis nursing skills involve not only teamwork, but good assessment skills, technical skills, therapeutic communication, collaborative skills, documentation skills, good attention to detail, and leadership qualities. Patients receive dialysis three times a week; patients receive their treatment on a Monday-Wednesday-Friday schedule or Tuesday-Thursday-Saturday schedule. My day begins with arriving to the unit upon opening at 6 a.m. and ensuring all safety checks with the water treatment and dialysis machines/equipment were completed by the certified hemodialysis technicians. First shift patients are assessed upon arrival at their scheduled times. In our unit, one nurse is assigned to work with one technician to care for our ‘chair side’ stations, and the other nurse is assigned with another technician to the ‘bed side’ stations. After I perform the patient assessment and document accordingly in our computer system, we weigh the patient and calculate the goal of fluid removal for the treatment. We then proceed to initiate dialysis treatment. We monitor the patients during treatment, obtaining vital signs every half hour, and discontinue treatment when completed. Post-dialysis, we assure that the patients’ vital signs are stable, patients have been weighed, and they are safely escorted out of the unit. We then clean and disinfect each station before the next shift’s patient arrives. Hemodialysis nurses must monitor patients during treatment, assure dialysis prescription is followed per MD order, administer prescribed medications, ensure vital signs are stable before treatment and before discharging from the unit, coordinate with MDs as needed, refer patients to MDs, dietitian, or social worker as needed, refer patients to vascular access center to implement ‘fistula first,’ provide patient education, monitor patients’ monthly lab results, adjust dialysis medications per company protocol, etc. At the end of the work day, we make sure that the unit is tidied up and that all equipment was disinfected and ready for use for the following day.”

“As a charge nurse in an acute care setting, I begin my shift getting report from the previous charge nurse. We discuss each patient’s needs and plan of care. We review staff assignments for the shift and discuss which staff may need more support based on their patients’ needs as well as the level of experience and proficiency of the staff working. After charge report, I complete chart reviews on all patients on my unit. I review lab results, nursing and provider notes, orders, and their daily schedule (peritoneal dialysis vs hemodialysis vs diagnostic procedures). I then round on each patient on the unit with the staff nurse to review the plan of care and discuss any questions I may have with the staff nurse. If there are urgent needs or questions, I assist the nurses with patient cares or by contacting providers. I then participate in multidisciplinary rounds and discuss treatment plans, help address any difficulty with patient compliance, and review discharge plans. Throughout the shift I provide support and education to staff nurses as needed.”

Challenges

Because nephrology nurses often work with their patients for months or years, Richards says the biggest challenge is making sure not to cross professional boundaries and maintaining appropriate relationships with people they may see as extended family. For Delos Santos, the challenge is to work with patient compliance. “Patients are expected to comply with their fluid, dietary, and medication regimens,” she says. Despite this, many remain noncompliant, which leads to hospitalization and even death. Rengstorf agrees that noncompliance is an issue. For nurses, it’s also tough to maintain a healthy work-life balance, as working with patients with chronic illness can be difficult. Patients can feel frustrated and have expectations that can take a toll on their mental health and coping skills. This can lead to caregiver fatigue.

The Rewards

“My favorite part of being a nephrology nurse is getting to know the patients and working with my team,” says Delos Santos. “We are a big part of their lives as we are their ‘lifeline’ in providing dialysis. I believe that creating an environment of comfort and feeling at home is an important part of what we do.” “I love working with patients and their families over many months and years. As nephrology nurses, we get to assist the patient with attempting to achieve the highest quality of life they can attain,” explains Richards. “It’s also rewarding to help patients to stay healthy on dialysis in an attempt to receive a kidney transplant and transition from chronic dialysis therapy to a more normal lifestyle with a transplant or to help a patient stay as healthy as possible in order to delay the start of dialysis therapy.” Rengstorf loves her job as well. “It’s rewarding to know the care you provide is literally life-saving. When patients share stories about milestones and celebrations they were able to participate in, it is rewarding to know they are alive for those moments because of the dedication of those in my profession.”